Maternal Diet and Breastfeeding

Caloric intake

Do breastfeeding mothers need more calories?

Yes. Breastfeeding mothers generally need more calories to meet their nutritional needs. To be well-nourished, breastfeeding mothers need 340 to 400 more kilocalories (kcal) per day than the amount they consumed before pregnancy. This means approximately 2,000 to 2,800 kcal per day for breastfeeding women versus 1,600 to 2,400 kcal per day for moderately active women who are not pregnant and not breastfeeding.

The number of additional calories needed for a breastfeeding woman is affected by her age, body mass index, activity level, and whether she is exclusively breastfeeding or both breastfeeding and formula feeding. Use the Dietary Reference Intake (DRI) Calculator for Health Care Professionals to estimate calorie needs.

See the Dietary Guidelines for Americans, 2020–2025 from the US Department of Agriculture (USDA) and Health and Human Services (HHS) for more information.

Vitamins and nutritional supplements

Should breastfeeding mothers take a multivitamin?

Maybe. Continued use of a prenatal vitamin after giving birth may exceed the iron and folic acid needs of a breastfeeding mother.

Some breastfeeding women, such as those with vegetarian and vegan diets, may not get adequate nutrients through their diet alone and may be at greater risk for nutritional deficiencies.

The recommended dietary allowances (RDAs) are the average amount of a vitamin or mineral that meets the daily nutrient needs of nearly all healthy people. The RDA for some nutrients, such as iodine and choline, increases while breastfeeding.

Therefore, diet alone may not ensure adequate nutrition for breastfeeding women. In these cases, breastfeeding mothers may benefit from taking a multivitamin supplement. Health care providers should work with breastfeeding women to determine appropriate dietary supplements during lactation.

Increasing nutrients

Should breastfeeding mothers increase intake of any nutrients?

Yes. A mother's need for iodine and choline increases during lactation. The Dietary Guidelines for Americans recommend breastfeeding women consume 290 micrograms (mcg) of iodine and 550 milligrams (mg) of choline daily throughout the first year after giving birth.

Iodine can be found in:

• Dairy products
• Eggs
• Seafood
• Iodized table salt

Choline can be found in:

• Dairy products
• Eggs
• Meats
• Some seafood
• Beans, peas, and lentils

Health care providers should work with breastfeeding mothers to determine if they need an iodine or choline supplement to achieve adequate intake.

Foods to avoid or limit

Should breastfeeding mothers avoid or limit any foods?

Generally, women do not need to limit or avoid specific foods while breastfeeding. Mothers should be encouraged to eat a healthy and diverse diet. However, certain types of seafood should be consumed in a limited amount. Some mothers may wish to restrict caffeine while breastfeeding.

Seafood

Fish is an excellent source of protein and contains essential vitamins and minerals. Yet breastfeeding women must be careful about the amount and types of seafood they consume. Most fish contain mercury that can pass from mother to infant through breast milk. This can have adverse effects on the brain and nervous system of the breastfed infant.

Breastfeeding women, as well as pregnant women and women of childbearing age, should follow the US Food and Drug Administration's and Environmental Protection Agency's advice about eating fish:

• Eat a variety of fish from the "Best Choices" and "Good Choices" categories on this chart.
• If you eat fish caught by family or friends, check for fish advisories. If there is no advisory, eat only one serving and no other fish that week.
• Try to avoid eating or feeding children the "Choices to Avoid" fish on this chart.
• Limit serving size. For adults, one serving equals 4 ounces of fish, measured before cooking.
• For weekly servings:
  • Limit to two to three servings (8 to 12 ounces) if all the fish are from the "Best Choices" section on this chart.
  • Limit to one serving (4 ounces) if the fish is on the "Good Choices" list on this chart.
    

Mercury can be harmful to the brain and nervous system of any person exposed to too much over time. Thus, lower mercury fish are a good choice for everyone. Learn more about mercury exposure and breastfeeding.

Caffeine

Caffeine passes from the mother to infant in small amounts through breast milk. This usually does not adversely affect the infant when the mother consumes low to moderate amounts. A low to moderate amount is about 300 milligrams or less per day, which is about 2 to 3 cups of coffee.

Irritability, poor sleeping patterns, fussiness, and jitteriness have been reported in infants of mothers with very high intakes of caffeine. Very high intakes are about 10 cups of coffee or more per day.

If an infant appears to be more fussy or irritable after the mother consumes high amounts of caffeine, she should consider decreasing her intake. Preterm and younger newborn infants break down caffeine more slowly, so mothers of these infants might consider consuming even less caffeine.

Common dietary sources of caffeine include:

• Coffee
• Sodas
• Energy drinks
• Tea
• Chocolate

Search "caffeine" in LactMed for more information on caffeine consumption and breastfeeding.

Vegan or vegetarian diet

Are there any recommendations for breastfeeding mothers who eat a vegan or vegetarian diet?

Yes. Breastfed infants of women who do not consume any animal products may have very limited amounts of vitamin B12. Low amounts of vitamin B12 can put infants at risk of neurological damage from vitamin B12 deficiency. Iron may also be of concern. Plant-source foods contain only non-heme iron, which is less readily absorbed by the body than heme iron found in red meat, fish, and poultry.

Health care providers should work with breastfeeding women eating a vegetarian or vegan diet to determine if they also need supplementation of iron, vitamin B12, and other nutrients, such as:

• Choline.
• Zinc.
• Iodine.
• Omega-3 fats (EPA/DHA).

For more information, see the Dietary Guidelines for Americans, 2020-2025.

Resources

Policy Statement: Breastfeeding and the Use of Human Milk—American Academy of Pediatrics

LactMed drugs and lactation database—US National Library of Medicine

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics—American Academy of Pediatrics Committee on Drugs

Advice About Eating Fish—US Food and Drug Administration and Environmental Protection Agency

Dietary Supplement Fact Sheets—National Institutes of Health